ADOPTION APPLICATION FORM
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THANK YOU FOR OPTING TO ADOPT!
This application form is to ensure that you and your potential new best friend are a good match in terms of environment, activity level and temperament.
Please complete the form in its entirety.
|Are you applying for a dog / puppy | |
|Name of the animal if applicable / request for home to be pre - | |
|approved | |
| |
|PERSONAL DETAILS |
|Name | |
|Surname | |
|Identity number | |
|Address | |
| | |
| | |
|Postal address | |
| | |
| | |
|E-mail address | |
|Home telephone number | |
|Work telephone number | |
|Cell phone number | |
|Car registration number | |
|Employer | |
|Occupation | |
|Amount of family members in the household | |
|Number of children in the household and age of the children | |
| |
|REFERENCE OF A FAMILY MEMBER OR FRIEND |
|Name | |
|Surname | |
|E-mail address | |
|Home telephone number | |
|Work telephone number | |
|Cell phone number | |
|Relation | |
| |
|PLEASE COMPLETE THE FOLLOWING |
|Have you adopted from Stafford Rescue Africa before | |
|Have you ever given an animal away and if so why | |
|Is your property securely closed | |
|If you stay in a complex or estate, do you have the necessary | |
|permission to adopt the animal | |
|Do you have a pool and if so is it secure for pets | |
|What kind of shelter is available for the pet | |
|Will this pet be chained or caged | |
|Are your current animals up to date with their vaccinations | |
|Have you had a sick animal on your property within the last 6 months| |
|and if so, what was the animal’s diagnosis | |
|Purpose for adopting: |Please see below |
|Guard dog /pet | |
|Working dog / pet | |
|Search & Rescue pet | |
|Family pet | |
|Breeding pet | |
❖ DO YOU INTEND TO KEEP THE ANIMAL:
|OUTDOORS | |INDOORS | |
❖ WHAT ARE THE SLEEPING ARRANGEMENTS FOR THE ANIMAL:
|Inside the house | |
|Kennel | |
|Garage or stoep (specify) | |
|Other | |
❖ DO YOU HAVE AN EXISTING VET? IF YES, WHO?
|YES | |NO | |
|VETS NAME | |
❖ WILL YOU BE WILLING TO HAVE A RESCUE REPRESENTATIVE VISIT YOUR HOME?
|YES | |NO | |
❖ DO YOU OWN ANY OTHER PETS?
❖ IF SO, WHAT KIND OF PETS, GENDER AND AGES AND WHETHER THEY ARE STERILIZED/CASTRATED?
|TYPE OF BREED |GENDER |AGE |STERILIZED |CASTRATED (YES/NO) |
| | | |(YES / NO) | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
❖ ARE YOU PLANNING TO MOVE IN THE NEAR FUTURE?
|YES | |NO | |
❖ VACATION ARRANGEMENTS/KENNELLING
❖ WHO CARES FOR YOUR PETS WHILST YOU ARE AWAY ON VACATION OR BUSINESS?
|REGISTERED BOARDING KENNELS |NAME: |
|DOMESTIC WORKER | |
|FAMILY | |
|NEIGHBOURS | |
|OTHER |SPECIFY: |
❖ DESIRED ANIMAL CHARACTERISTICS
❖ PREFERRED GENDER OF ANIMAL
|MALE | |FEMALE | |
❖ COAT PREFERENCE
|Short | |Medium | |Long | |
❖ SIZE PREFERENCE OF THE DOG (where applicable)
|Small | |Medium | |Large | |
❖ BREED PREFERENCE
| |
| |
| |
❖ FOR VARIOUS AND IMPORTANT REASONS, WE REQUIRE ALL ANIMALS ON THE PROPERTY TO BE STERILIZED AS WELL, PLEASE TALK TO OUR STAFF FOR FURTHER INFORMATION ON HOW WE CAN ASSIST.
FOR OFFICE USE ONLY
|If a puppy sterilisation date due: |DATE FOR STERILISATION: |
| | |
|Property Checker |Name: |
|Date check was done | |
I HAVE READ AND UNDERSTOOD THIS FORM IN ITS ENTIRETY
SIGNED ON THIS THE____DAY OF _____________20___ AT _______________
______________________
APPLICANT SIGNATURE
LEGAL STUFF – PLEASE READ
This agreement serves to confirm the following.
• Our animals legally belong to Stafford Rescue Africa and are rehomed or adopted solely in our discretion.
• We have the right to refuse an adoption without giving reasons.
• We cannot accept responsibly for the temperament or behaviour of the animal.
• Should any information on this form be found to be false and/or incorrect and/or not complied with, Stafford Rescue Africa has the right to investigate and reclaim / remove the animal without notice.
• This animal should always be treated in a loving and kind manner, it is expected that you will provide this animal with access to adequate shelter, food and water and any medical treatment it may require as well as to see to its emotional well-being at your own expense.
• No animal adopted from Stafford Rescue Africa may be used as a performance animal / security animal for any reason whatsoever.
• Neither Stafford Rescue Africa, nor its employees, volunteers, directors, affiliates or members can be held liable for any loss of property, damage or injury as a result of adopting this animal.
• Unfortunately, in most instances we have no idea where our puppies or dogs come from as most of them are dumped or found as strays.
• All puppies or dogs will receive their first vaccination and, in the event, that they are not adopted before the second vaccination or annual vaccination is due, we will provide them with the same.
• Although all reasonable precautions are taken, we cannot guarantee that puppies or dogs will not become ill or pass away as a result of illnesses.
• Puppies or dogs can get sick and become ill. If you find your puppy or dog is vomiting and / or has a runny tummy, is off its food or shows signs of illness, please call us immediately, we will assist where possible, this may include referring the animal to our vet, or please take your puppy or dog to a vet immediately. Please note however that expenses related to such assistance or care will however still be for the account of the person who has signed this document.
By adopting a puppy from Stafford Rescue Africa you agree to the following terms:
PUPPY OR KITTEN STERILIZATION/CASTRATION CONTRACT
Stafford Rescue Africa animals are adopted out with a strict and non-negotiable sterilization contract:
I, ………………………………………………………………………………………………… (Full name),
Identity No. …………………………………………………………………………………………..
Address ……………………………………………………………………………………………………………..
Contact Numbers: …………………………………………………………………………………………………
❖ Do hereby acknowledge that the puppy I am adopting is still too young to be sterilized. Therefore, I confirm and agree that I will contact Stafford Rescue Africa to arrange to have the puppy sterilized / castrated on the date specified. (Approximately 6 months of age). For various and important reasons, we require all animals on the property to be sterilized as well, please talk to our staff for further information on how we can assist. You hereby agree and undertake that in the event that you may have unsterilized animals on your property that you will ensure that they are sterilized as soon as possible before or after a successful adoption of any animal from the shelter, this being applicable whether you adopt a puppy or dog.
Name of animal: …………………………………….. Breed: ……………………………………………..
Current age of animal: ………………………………………… Date of sterilization/castration …………………..
Our adoption fee (R2500 for dog under 12mnths of age and R1800 for dogs over the age of 12mnths) includes the prepaid cost of the sterilization/castration of the animal, microchipping, dewormer and vaccinations up to date and in light of this there will be no further charges.
VACCINATION & DEWORMING SCHEDULE CONTRACT
Below you will find the standard vaccinations and deworming that your puppy must receive and it is very important that these are undertaken, otherwise you are leaving your puppy open to contract Parvo, Distemper and other diseases and also putting any other animals your puppy comes into contact with at risk. These diseases are highly contagious. It is part of your contract that you undertake to have these done at your local vet where the vet will undertake the deworming at the same time.
There after your animal should be dewormed as set forth herein under and if you have children in the home, it is recommended that deworming takes place once every three months.
|VACCINATION OF DOGS / CATS |
|6 weeks old |1st Vaccination |
|21 days after 1st Vaccination |2nd Vaccination |
|21 days after 2nd Vaccination |3rd Vaccination (or Parvo) and Rabies |
|Annually |Combination vaccine |
|After the second Rabies vaccination. Rabies is administered every three years. |
Puppies should be wormed at 2, 4, 6, 8 and 12 weeks of age, and then every three months for the duration of its life
Deworming of adult dogs should occur every three months for the duration of the animal’s life.
PUPPY / DOG RETURN TO STAFFORD RESCUE AFRICA
No matter what the reason – if you are unable to keep your puppy or dog, immediate arrangements must be made with Stafford Rescue Africa for the return of the animal. Should you advertise the animal on any platform whatsoever, offer the animal to a friend or family or attempt rehoming in your own capacity, you will be violating this contract.
I hereby acknowledge that I have read, understood and agreed to the terms set out above and that should any of the terms in the contract be breached, Stafford Rescue Africa receives the right to reclaim the animal from me.
I have had the opportunity to request for assistance in the interpretation or applicability of the terms and conditions contained herein.
SIGNED ON THIS THE________DAY OF _________________20_____ AT ___________________
______________________
APPLICANT SIGNATURE
❖ Contact us on:
Lauren Mallet 083 701 1007
❖ Check out our facebook page:
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❖ E-mail us on:
staffordrescueafrica@
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